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  • Title: [Oral contraceptives and venous diseases].
    Author: Dapunt O.
    Journal: Arch Dermatol Forsch; 1972; 244():490-5. PubMed ID: 4648758.
    Abstract:
    Studies with laboratory animals have revealed substantial modifications of the vascular wall after administration of estrogen-gestagen combinations. Hypertrophy and hyperplasia of the muscle cells, fragmentation and reticular fiber, plexus, attenuation of the fibers, and increased collagen deposits in the adventia were observed in rabbits after intake of hormonal preparations similar to those used as contraceptives. Ludwig observed a "washing out" process in which the acidic mucopolysaccharides are disloged against the vascular lumen. The clinical significance of these estrogen-induced changes has not yet been truly evaluated. Studies concerning functional modifications of venous circulation are contradictory. Goodrich observed retardation of the venous bloodstream and, plethysmographically, a decrease in venous tonus in the lower extremities. It is certain that increased progesterone in the body results in a 20-30% extension of the veins, and that fibrinogen, prothrombin, and factor X become more active. Statistics show a higher risk of fatal thromboembolisms in women, particularly those over 35, using oral contraceptives. Oral contraceptives are contraindicated for women with embolisms or thrombosis, large subfascial veins, or Marfan syndrome (weakness of connective tissue in the large veins). The sequential method of hormonal contraceptives produces fewer venous disorders than the combination method. The estrogen component should not exceed .05 mg. A pause of 3-4 months is recommended after 9-12 cycles of medication with hormonal contraceptives. These findings indicate that dosage and duration of treatment with hormonal contraceptives must be carefully considered.
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